A
child who doesn't like doing math homework may be diagnosed with
the mental illness developmental-arithmetic disorder (No.315.4).
A child who argues with her parents may be diagnosed as having
a mental illness called oppositional-defiant disorder (No.313.8).
And people critical of the legislation now snaking through Congress
that purports to "end discrimination against patients seeking
treatment for mental illness" may find themselves labeled
as being in denial and diagnosed with the mental illness called
noncompliance-with-treatment disorder (No.15.81).

The
psychiatric diagnoses suggested above are no joke. They represent
a few of the more than 350 "mental disorders" listed
in the American Psychiatric Association's (APA) Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV), the billing bible
for mental disorders which commingles neurological diseases with
psychiatric diagnoses. (Click here to see more examples of the
mental disorders listed in the DSM-IV.) Whether the described
diagnoses are real diseases or subjective speculation, science
is at the heart of the debate about whether lawmakers will require
employers and insurers to cover mental illness on the same level
as physical disease.

Advocates
of the Mental Health Equitable Treatment Act of 2002 (S 543),
and its sister proposal in the House (HR 4066), are seeking to
expand the 1996 "mental-health parity" legislation.
It mandates employers with more than 50 employees and that offer
mental-health coverage to provide insurance benefits equal to
those of standard health care, such as surgery and physician visits.

The
pending proposals would expand the 1996 legislation to require
that caps, or limitations on coverage, be the same for mental
illnesses as those provided for medical illnesses, in the name
of so-called mental-health parity. When it comes to "mental
illness" and "medical illness" however, there is
no scientific parity between the two schools of thought. That
is, only one is based in physical science.

Proponents
of mental-health parity believe, and have for the most part successfully
convinced lawmakers, that the mental illnesses described in the
DSM-IV are medical diseases. For example, obsessive-compulsive
disorder (OCD) is considered medically equivalent to, say, measles
or anemia.

But
critics patiently explain that the psychiatric "mental illness"
as described in the DSM-IV is a subjective diagnosis that lies
in the eye of the beholder rather than in proved medical science.
How this issue is decided, these critics say, likely will determine
whether millions of American families will be priced out of health
insurance.

Fred
Baughman, a San Diego neurologist and leading critic of the alleged
mental illness called attention-deficit/ hyperactivity disorder
(ADHD) (see picture profile, Feb. 18), tells Insight the question
that must be answered before a mental illness can qualify as a
disease is this: "Where is the macroscopic, microscopic or
chemical abnormality in any living patient or at death/autopsy?"

Baughman
explains: "No one is justified in saying anyone is medically
abnormal/diseased until such time as they can adduce some such
abnormality. This, by the way, would apply to a person suspected
of having diabetes or cancer."

The
fact is, Baughman adds, "There is no psychiatric diagnosis
for which any part of this question can be answered in the affirmative.
In other words: no abnormality; no disease. There is no confirmation
of abnormality in the brain in life or at autopsy for any of the
psychiatric diagnoses. And they [in the psychiatric community]
don't say this because it's part of the propaganda campaign to
make patients out of normal people. The findings at autopsy would
be very specific and would reveal whether it is a diseased brain
and, if so, which disease it is. There is no proof in life or
at autopsy of any of the alleged psychiatric mental illnesses,
including schizophrenia, psychosis, depression, OCD or ADHD."

Here
is Baughman, an internationally respected neurologist, denying
there is any such thing as an authentic diagnosis of psychiatric
disease at precisely the same time that Congress appears to be
getting ready to mandate equal and comparable coverage of psychiatric
and medical diseases as the same thing. Perhaps lawmakers haven't
asked for the supporting science, or perhaps it has just been
withheld from them.

To
try to find out which, Insight sent carefully prepared questions
about mental illness to the APA and the National Institute of
Mental Health (NIMH), the two leading advocates of mental-health
parity. Here are those questions:

How
many disorders that are listed in the DSM-IV are curable?

What
documentable, confirmatory, diagnostic, physical abnormality is
found in schizophrenia, ADHD and depression?

What
confirmatory, diagnostic tests are available and currently utilized
to detect a chemical imbalance?

The
APA would not respond to the questions and the NIMH, which claimed
not to get involved in policy issues, deferred to a psychiatrist
who refused to speak on the record. Both groups did, however,
suggest reviewing the 1999 Surgeon General's Report on Mental
Health, which Insight promptly read. The report contained the
remarkable statement that, "in the United States, mental
disorders collectively account for more than 15 percent of the
overall burden of disease from all causes and slightly more than
the burden associated with all forms of cancer."

But
nowhere in the surgeon general's report was there any reference
to a single confirmatory, diagnostic test that proves any physical
abnormality in any psychiatric diagnosis. More importantly, several
chapters into the report the surgeon general admits what Baughman
and other neurologists have been saying for years: "The diagnosis
of mental disorders is often believed to be more difficult than
diagnosis of somatic or general medical disorders since there
is no definitive lesion, laboratory test or abnormality in brain
tissue that can identify the illness" [emphasis added].

Naturally,
one might assume, it would be difficult to diagnose a mental illness
if there were no confirming physical evidence that one exists.
And one might even ask the surgeon general how he could make the
statement that "mental disorders collectively account for
more than 15 percent of the overall burden of disease" when
he admits later in the report that there is no physical proof
thus far of mental disease in any of the psychiatric diagnoses.

More
important, critics say, is his honest admission that there is
no proof of any physical abnormality that causes any psychiatric
mental disorder. This begs the Letter: If there is no way to
prove that a single psychiatric mental illness exists in life
or death, how does one diagnose something that doesn't exist and
then require insurance companies to pay for treatment?

While
the observations of the nation's top medicine man seem crystal
clear  and are, in fact, a carbon copy of what critics such
as Baughman long have been saying about mental disorders 
apparently the sponsors of the pending legislation missed the
surgeon general's report. According to Allison Dobson, communications
director for Sen. Paul Wellstone (D-Minn.), a cosponsor of the
Senate bill, "We know that mental illness is valid based
on the volumes of science that have been presented to the senator.
The mental illness thing has pretty much been proved by science."

Sen.
Pete Domenici (R-N.M.), the biggest cheerleader for requiring
mental-health parity, didn't respond to Insight's calls. But Michael
Zamora, the policy adviser for Rep. Patrick Kennedy (D-R.I.),
a cosponsor of the House parity legislation, tells Insight: "We've
had a number of specialists from NIMH who have talked about what
they're doing. While they don't have any diagnostic criteria developed
yet, they are making advances and starting to document the linkages
between the physical and mental. But they haven't necessarily
been able to establish yet exactly how these are working."

Indeed,
says Kennedy's spokesman, "I'm pretty confident and trusting
that the science base of the National Institute of Health, the
surgeon general and Nobel laureates have researched this stuff
when they say there is a science base behind mental illness. I
know that the congressman is confident that the surgeon general
and our premier medical-research facility, NIMH, is not full of
quacks."

But
that's not the issue, critics say. It's whether as-yet medically
proved illness ought to be paid for by insurance companies, employers
and patients at the same levels as diseases science physically
has confirmed.

Neither
former surgeon general David Satcher (author of the 1999 Surgeon
General's Report on Mental Health) nor former NIMH director Steven
Hyman would agree to an interview to discuss these matters. Given
the official admission by former surgeon general Satcher it is
tempting to speculate why the interviews were denied. What is
unclear is why lawmakers continue to push for mental-health parity
with medical disease when, to date, there is no physical proof
that any of the psychiatric mental disorders can be confirmed
as abnormalities of the brain.

As
recently as late May sponsors of the House parity legislation,
Marge Roukema (R-N.J.) and Kennedy, continued the push to "end
discrimination against patients seeking treatment for mental illness."
In a "Dear Colleague" letter to members of the House
of Representatives entitled "The Truth About The Impact of
Mental Health Parity," Roukema and Kennedy attempted to "eliminate
any confusion about the DSM." The authors sought to give
credence to the APA's diagnostic manual, explaining that, "for
50 years, DSM has been widely recognized as the 'international
standard' system for classifying mental disorders," and the
"DSM is the state of the art of the knowledge base."

The
"Dear Colleague" advocacy letter closed by observing:
"There will always be those who oppose ending insurance discrimination.
While we strongly disagree with them, we look forward to
a debate on the facts." Perhaps so. But nowhere did the letter
so much as mention that none of the psychiatric diagnoses in the
DSM are based in physical science such as abnormalities of the
brain found in life or death.

Meanwhile,
independent groups representing businesses and other insurers
say they are alarmed about the financial burden the proposed legislation
is certain to produce. It is widely estimated that nearly 45 million
Americans already are without health insurance and there is little
doubt that mandating expanded coverage of undefined "mental
disease" will run up costs and premiums still further. No
one knows how much, but consider these guesstimates:

In
2001 the Business Journal estimated the likely increase in costs
would be as high as 40 percent; the National Association of
Health Underwriters suggests insurance premiums likely would
increase by 11.4 percent.

The
National Federation of Independent Businesses (NFIB) conducted
a study among its 600,000 members that indicates even existing
state benefit mandates could increase premiums by as much as 30
percent.

An
April 2002 PricewaterhouseCoopers report estimates that government
mandates and regulations, which increased 25-fold from 1970 to1996,
will add $10 billion to the overall increase in health premiums.

Charles
N. Kahn III, president of the Health Insurance Association of
America (HIAA), testified before Congress in 1999 that coverage
for psychiatric hospital stays alone already had increased premiums
by 12 percent.

In
Maryland, a 1992 Blue Cross/Blue Shield Association study documented
"the most expensive individual benefits were estimated to
be substance-abuse and mental-health-care services." Outpatient
mental-health-care visits increased more than 78 percent once
mandates were expanded  from 448,000 in 1983 to 800,000
in 1986.

The
NFIB, the National Association of Manufacturers, the U.S. Chamber
of Commerce and the HIAA are among the many organizations opposed
to the parity legislation. According to Randy Clerihue, a spokesman
for HIAA, "We don't like this bill because it's going to
raise the cost of health care. It's not that we don't think mental-health
services aren't important, but we don't think government should
be mandating the kind of insurance employers purchase on behalf
of their employees. The problem comes when you have a mandate
that forces everyone to pay for something whether they want it
or not. We're headed in the direction of mandating everyone out
of health insurance."

Each
of the many business and insurance groups with which Insight spoke
expressed similar sentiments and each was aware of a little-discussed
fact: While lawmakers seem prepared to force private insurers
to pay for the increase in insurance premiums for mental disorders,
which then will be passed along to employees in the form of higher
costs and lost take-home pay, the federal government itself is
not included  neither Medicare nor Medicaid are included
in the mandate. Imagine the uproar if payments for these had to
be increased 40 percent or so!

Bruce
Wiseman, U.S. national president of the Citizens Commission on
Human Rights, a nonprofit organization committed to ending abuses
in psychiatry, tells Insight: "The government won't include
Medicare and Medicaid in parity legislation because they know
the taxpayers couldn't afford it  it would break the bank.
And even excluding those programs it will break the bank because
mental illness is subjective."

According
to Wiseman, "Numerous studies show psychiatrists tend strongly
to use health-insurance benefits up to the point that they are
exhausted, at which point the patient is declared cured. For instance,
a person is found to have anxiety disorder up to the insurance
cap, whereupon the psychiatrist tells them they no longer have
it. This kind of diagnosing would milk the system dry. In this
legislation, the government is saying that if there's a million-dollar
cap on treating a patient's cancer then there has to be a million-dollar
cap on treating shyness when it is called social-anxiety disorder.
So once the person gets 'treated,' the bill reaches the cap and
they're pronounced cured. Such diagnoses will run insurance costs
into the stratosphere. Parity legislation is ripe for abuse if
for no other reason than bogus diagnosis."

The
former surgeon general, however, might put an end to the debate
if he were to testify before Congress about what he wrote in the
1999 report  that there is no known abnormality in the brain
as a marker for any of the psychiatric diagnoses. Meanwhile, the
critics say, they will continue to insist that until a physical
cause of mental disorder is identified it is not comparable to
medical disease and there should be no government mandate that
insurance companies treat them the same.

Kelly
Patricia O'Meara is an investigative reporter for Insight magazine.